This kit will provide a comprehensive overview of Pacific Fertility Center, and for straightforward, accessible information about infertility causes, diagnosis and treatment.
Pacific Fertility Center
Pacific Fertility Center's internationally acclaimed physicians and embryology team are leaders in the field of reproductive medicine who pride themselves on a focused, patient-centered approach. Our extensive experience and ongoing involvement in research and new technology enables us to meet our patients' needs at every level.
Pacific Fertility Center was founded in 1999 by UCSF physicians Eldon Schriock, Carolyn Givens and Isabelle Ryan and long-time private practitioners Carl Herbert and Philip Chenette. In 1999, PFC also welcomed High Complexity Clinical Laboratory Director Joseph Conaghan, whose exceptional team of embryologists has earned a reputation for meticulous work, secure conditions and high standards of care. PFC's team has since been joined in 2011 by Columbia University-trained reproductive endocrinologist Liyun Li, MD.
Pacific Fertility Center accommodates our patients' diverse needs with an array of diagnostic and treatment options, including in vitro fertilization (IVF), preimplantation genetic diagnosis (PGD), intrauterine insemination (IUI) and egg donation. We are able to treat challenging problems like low sperm production with advanced embryology procedures such as ICSI and testicular sperm extraction (TESE), wherein even a single sperm may be injected into an egg to enable fertilization. Such exceptional technology has enabled us to help thousands of patients overcome infertility and build healthy families.
Pacific Fertility Center is a nationwide leader in the technologies involved in Fertility Preservation, preserving eggs and embryos for cancer patients that may have to undergo treatments that may cause infertility. We also believe in and encourage Egg Freezing for women that are concerned about advancing age, allowing women to have some insurance against the "biological clock."
Each Pacific Fertility Center physician is a certified subspecialist in Reproductive Endocrinology and Infertility (REI) with the American Board of Obstetrics and Gynecology, which means that they have received the highest level of certification in the assisted reproductive technology (ART) field.
Our physicians have been the subject of numerous print and broadcast media interviews and enjoy conveying information to health consumers. For interviews with our physicians as well as with nurses, counselors and patients, please contact PFC by email at email@example.com.
What is infertility?
A common, textbook definition of infertility is the "failure to conceive following one year of unprotected sexual intercourse." A more precise definition of infertility takes into account the age of the woman trying to conceive, as this is a crucial factor in this process:
Infertility is the inability to conceive following one year of unprotected intercourse if under 35 years of age or six months if over 35.
In addition to the age of the woman, there are a number of factors that can contribute to an individual or couple's inability to conceive, and it is important to consider all of these in an initial evaluation.
While we often associate infertility with women, this distressing condition is just as likely to be caused by issues in the male partner. A third of the time, fertility problems are found in men, a third of the time in women and a third of the time in both partners. A thorough fertility evaluation will take into account the physical health and medical history of both the female and male partner, as well as the age of the female partner, which is always considered a crucial factor.
In addition, some individuals such as single or lesbian women or single or gay men need fertility assistance through the use of donor sperm, donor eggs or surrogacy. Pacific Fertility Center is one of the few fertility centers in the U.S. with its' own Egg Donor Agency, providing egg donors for the majority of our patients that need these services.
How we evaluate and diagnose infertility
An individualized evaluation from a fertility specialist can help ease frustration and worry by providing information, answers and direction as to further diagnosis and treatment. Evaluation of both partners is the first step to taking full advantage of a woman's reproductive potential and timeline. A fertility evaluation will include a complete medical history of the male and female partner, and also the age of the female partner.
Pacific Fertility Center suggests following these guidelines to know when to begin a fertility evaluation:
- Women under the age of 35 who have not conceived after a year of well-timed intercourse
- Women between the age of 35-39 who have not conceived after six months of well-timed intercourse
- Women 40 and over who have not conceived after three months of well-timed intercourse.
- Men with low sperm counts
- Men or women with known fertility risk factors
- Women that may need to use an egg donor to conceive because of age or premature menopause
- Single women or lesbian couples who may need fertility services
- Single men or gay male couples seeking conception through donor eggs and surrogacy
Learn more about how fertility is evaluated and diagnosed.
In some cases, a woman may be able to get pregnant on her own (without fertility treatment) but it simply isn't happening. This is sometimes referred to as 'sub-fertility.' In these cases, our doctors can provide guidance as to how to work with the natural cycle and maximize potential. When evaluation indicates that the odds of conception could be significantly improved by fertility treatment, we will recommend this option and discuss next steps.
There are a few specific medical conditions for which fertility treatment is always necessary in order for conception. This is sometimes referred to as 'true infertility' and includes:
- Women with blocked fallopian tubes
- Women with no uterus or no egg follicles (as occurs in menopause or premature ovarian failure)
- Men who have no sperm
Fortunately, there are a range of options for such patients, including IVF therapy, third party egg or sperm donation or the use of a gestational carrier (surrogate).
National Infertility Statistics
As of 2012, the statistics below are the latest from the US Centers for Disease Control and Prevention's National Survey of Family Growth (2002).
As of 2012, the statistics below are the latest from the US Centers for Disease Control and Prevention's National Survey of Family Growth (2002).
- Percent of all married women 15-44 years of age who are infertile (i.e., who are not surgically sterile, have not used contraception in the past 12 months, and have not become pregnant), 2002: 7.4%
- Percent of married childless women 15-44 years of age who are infertile by current age, 2002:
Total (15-44): 16.6%
- 15-29 years: 11.0%
- 30-34 years: 16.9%
- 35-39 years: 22.6%
- 40-44 years: 27.4%
NOTE: The difference between impaired fecundity and infertility: "Infertility" is measured only for married couples and infertility refers only to problems getting pregnant. "Impaired fecundity" includes married and unmarried women and includes problems getting pregnant and problems carrying a baby to term.
- Percent of women 15-44 years of age in 2002 (of all marital statuses) who have impaired fecundity (i.e., who are not surgically sterile, and for whom it is difficult or impossible to get pregnant or carry a pregnancy to term): 11.8%
- Percent of married childless women 15-44 years of age who have impaired fecundity by current age, 2002:
Total (15-44): 25.3%
- 15-29 years: 17.3%
- 30-34 years: 24.5%
- 35-39 years: 33.9%
- 40-44 years: 42.8%
Percent of women 15-44 years of age who have ever received any infertility services, 2002: 11.9% (7.3 million).
- Percent of childless women 15-44 years of age who have ever received any infertility service, by current age, 2002:
Total (15-44): 7.1%
- 15-29 years: 2.9%
- 30-34 years: 17.3%
- 35-39 years: 15.2%
- 40-44 years: 29.1%
According to the American Urological Association (AUA), in up to 50 percent of couples having difficulty getting pregnant, the problem is at least in part related to male reproductive issues.
For an more extensive explanation of these terms, click here.
Assisted Reproductive Technologies (ART):
Infertility treatment procedures that require laboratory handling of sperm and /or eggs. These include such therapies as:
- In vitro fertilization
- Ovum donation
- Intracytoplasmic sperm injection
- Pre-Implantation Genetic diagnosis/screening
- Egg and embryo cryopreservation (freezing)
Also referred to as an oocyte, this is the largest cell in the human body. The egg unites with sperm to make a one-celled organism called a zygote which will contain a complete set of genetic information (DNA). Once fertilization occurs, the zygote divides to blastocyst stage, eventually becoming an embryo capable of implanting in the woman's uterus and developing into a baby.
This is a process in which a woman donates her eggs to another woman who is unable to produce viable eggs on her own. The donor first receives fertility stimulating medication to enhance the number of eggs produced. Eggs are retrieved or harvested in a brief surgical procedure. In the laboratory, eggs are fertilized with recipient partner's sperm; and resulting embryos are then transferred to the uterus of the recipient.
Egg donation may be recommended in the following situations:
- Absence of the ovaries, either due to a congenital condition or to surgical removal
- Premature menopause (also called premature ovarian failure) in which the ovaries are no longer able to produce egg follicles.
- Older age, in which eggs produced are less viable
- Decreased ovarian reserve – low egg viability at any age
- Inadequate response to fertility (ovary stimulating) medications
Egg donors are most often young women who have evidence of good fertility and egg production. Most egg donations are done anonymously, however known donors are also acceptable in many instances. Learn more about PFC's Egg Donor Agency.
This is a minor surgical procedure to remove eggs from a woman's ovary as part of the IVF process. gg retrieval is done under heavy sedation and is therefore painless. In the procedure, a very thin instrument called an ultrasound probe fitted with a tiny needle is passed through the wall of the vagina and into each ovary. The needle punctures each egg follicle and removes the egg through gentle suction. Eggs are immediately transferred to our laboratory. Anesthesia wears off quickly once egg retrieval is concluded. Patients may feel some minor cramping in the ovaries that is treated with appropriate medications. Learn more about egg retrieval.
A fertilized egg that has begun the cycle of cell division. A one day old embryo is called a zygote. At five days of life, just prior to replacement back into the womb, the embryo is called a blastocyst. When an implanted embryo reaches 8 weeks of age, it is now known as a fetus.
This is the process of depositing an embryo (fertilized egg) inside the woman's uterus. Embryo transfer most often occurs 3 to 5 days following egg retrieval. Embryos are placed inside a special catheter (a very thin tube), which is guided through the cervix and into the uterus. Embryos are gently placed into the uterus and the catheter is removed. This procedure requires no anesthesia, and is done in a position similar to a pelvic examination for a Pap smear. After transfer, the woman rests for 15 minutes and then is able to go home, where a day of rest or very gentle daily activity is recommended.
An embryologist is a highly specialized laboratory technician/scientist that works with and handles sperm, eggs and embryos in the in vitro fertilization (IVF) process. Embryologists also perform ICSI and PGD procedures as well as perform semen analysis, sperm preparations and sperm, egg and embryo freezing.
The unification of sperm and egg to form a single-celled organism (zygote) containing a complete set of 46 chromosomes, half from the egg and half from the sperm. The zygote, considered the earliest stage of human life, rapidly divides, becoming first an embryo and eventually a fetus.
This refers to the process of a woman undergoing in vitro fertilization for the purposes of cryopreserving (freezing) either unfertilized eggs or embryos (fertilized eggs). Initially, fertility preservation was primarily done for women facing surgery or cancer chemotherapy treatments that might affect her ability to produce eggs in the future. However, it is now more commonly also used by women that are concerned about ovarian aging.
Approximately eight weeks after fertilization, the embryo's rapid cell division and differentiation marks the beginning of the fetal period of development, during which the development of human characteristics can be seen.
A gestational carrier (often referred to as a "surrogate") is a woman who agrees to carry and deliver the child of another woman who is unable to carry a pregnancy. A gestational carrier carries embryos created from the eggs and sperm of the Intended Parents created through IVF and gestates the pregnancy. In gestational surrogacy with IVF, the gestational carrier does not contribute any genetic materials; the egg and the sperm are extracted from the prospective parents or a donor, fertilized in the laboratory with IVF and then implanted into the uterus of the gestational carrier.
A gestational carrier may be recommended in the following situations:
- Absence of a uterus (womb), due to previous surgery or a congenital condition
- Irregular or very scarred uterine cavity
- Recurrent miscarriages
- Inability to conceive using IVF treatment despite good embryos
- Inability to carry a pregnancy due to a medical condition that might affect the mother's or the fetus' health.
ICSI (Intracytoplasmic sperm injection)
(ICSI) is the process of injecting a single sperm into an egg. This technology enables fertilization in cases of severe male factor infertility, where the male partner has low sperm production or poor motility (forward movement) and is therefore at risk to have fertilization failure. ICSI is always necessary in cases where sperm is surgically removed from the testicles (surgical removal of sperm is referred to as a TESE procedure). Learn more about these below.
In ICSI, an embryologist uses a very fine needlepoint pipette (a tiny instrument similar to an eye dropper) to grasp a single sperm, insert it gently into the egg and then release the sperm.
Intrauterine Insemination (IUI)
A fertility treatment that involves injecting prepared sperm into the woman's uterine cavity. The male partner first gives a sperm sample. Sperm is 'washed,' or specially treated in the laboratory. Sperm may also be obtained from a sperm bank for intrauterine insemination. The prepared sperm is then injected into the woman's uterus via a very thin tube called a catheter. Before IUI, the woman may also be treated with fertility medications that stimulate ovulation. IUI with fertility medication is commonly used to treat such conditions as:
- Abnormal cervical mucus. Normally the cervical mucus serves as a reservoir to protect, nourish sperm and enable it to swim through the uterus to the fallopian tubes. In cases where the mucus cannot serve this function, IUI can deliver sperm directly into the uterus.
- Mild male factor infertility. In cases where sperm may be slow swimming or low in number, the IUI process can increase chances of delivery to the uterus.
- Unexplained fertility
- Single or lesbian women using donor sperm
- Women whose partners have no sperm production whatsoever
IVF (In Vitro Fertilization)
Literally "fertilization in glass," IVF is a procedure wherein the female egg is fertilized with the male sperm in a Petri dish or test tube, in the laboratory. IVF involves several steps:
- Over a course of weeks, the woman is given fertility drugs that stimulate her ovaries to produce a number of mature eggs
- At the proper time, the eggs are retrieved (see egg retrieval, above)
- Eggs are fertilized in the laboratory with her partner's or donor sperm
- Three to five days after egg retrieval, embryos are transferred into the woman's uterus
Learn more about the IVF process.
Ovarian reserve is a term used to refer to a woman's reproductive potential; that is, her chances of successful pregnancy with her own eggs. As part of the body's natural aging process, the number of viable, healthy eggs diminishes over time, leading to more problematic pregnancies and lower pregnancy rates. While a woman continues to ovulate monthly until menopause, the eggs produced are increasingly at risk for genetic abnormalities such as Down syndrome.
Ovarian reserve is evaluated using two common blood tests:
- FSH and Estradiol blood test to measure FSH, the primary hormone responsible for prompting egg production, and estradiol, the most important estrogen hormone, responsible for reproductive anatomy health and function. These tests must be done in the very early part of the menstrual cycle to be valid.
- Anti-Mullerian Hormone is a hormone directly produced by the ovaries and reflects the number of viable eggs present. Because it is continually produced in the ovaries of fertile women, it can be tested at any time in the menstrual cycle.
- Antral Follicle count is an ultrasound measurement of small follicular cysts residing in the ovaries at any point in time and reflects how responsive a woman might be to fertility medications.
Although these tests are used to make estimates of a woman's chance to become pregnant, it is more accurate to say that a woman's age is the one best predictor of live birth.
See Egg Donation.
The organ responsible for providing the developing embryo with oxygen and nutrients, and removing waste via the umbilical cord. The placenta is connected to the uterine wall and grows as the pregnancy progresses, continuing to secret hormones to regulate and maintain fetal health.
Preimplantation Genetic Testing
A technology wherein embryos are analyzed for genetic and chromosomal abnormalities before they are implanted into a woman's uterus. Genetic testing can greatly increase the chances for healthy pregnancy in patients who may carry a genetic disease. In Pre-Implantation Genetic Testing (PGT-A), embryos can be assessed prior to embryo transfer for whether or not there are any chromosomal abnormalities such as Trisomy 21, or Down Syndrome.
This term refers to a woman who receives eggs from an egg donor. Donor eggs are fertilized with sperm from the recipient's partner (or from a sperm donor). The resulting embryos are then transferred to the recipient's uterus, enabling her to carry a pregnancy to term. Prior to embryo transfer, the recipient undergoes a 2-3 week period of hormonal treatment to ready the uterus for pregnancy.
See Gestational Carrier
TESE (Testicular Sperm Extraction)
A surgical procedure performed in which sperm is removed directly from the testicles or obtained through a biopsy (tissue sample). TESE is often recommended for men with poor sperm production in the testicles and no sperm in the ejaculate. It is usually the only means of obtaining sperm in cases of Azoospermia, where there are no sperm in the ejaculated seminal fluid.
TESE sperm must be used in conjunction with IVF with ICSI, in which retrieved sperm are injected directly into the female partner's eggs. Testicular sperm does not have the capability to bind to eggs and must be injected into them. The fertilized eggs then are implanted into the woman's uterus (embryo transfer).
A diagnostic procedure used to identify "pockets" of isolated sperm in the testicles of men who have very low sperm production. Once these areas are located a TESE procedure can be done to extract the sperm for use with IVF with ICSI.
Third Party Parenting
The involvement of a third person (outside of the prospective parents) to create a baby. A third party parent may be an egg donor, sperm donor, or a gestational carrier.
Considered the earliest stage of human life, a zygote is a newly fertilized egg. This one-celled organism contains a complete set of genetic information (DNA), half from the male and half from the female. The zygote divides rapidly to the blastocyst stage, eventually becoming an embryo.
Our Fertility Team
Pacific Fertility Center staff is composed of highly trained experts who are leaders in the fields of embryology and reproductive medicine.
Our physicians and embryologists are recognized in the United States and internationally for their years of clinical experience and academic and scientific contributions. Alongside an accomplished team of nurses and counselors, they are dedicated to providing excellent, sensitive and ethical care for those seeking fertility solutions.
Each Pacific Fertility Center Partner physician is a certified subspecialist in Reproductive Endocrinology and Infertility (REI) with the American Board of Obstetrics and Gynecology, which means that they have received the highest level of certification in the assisted reproductive technology (ART) field.
Our board certified, High-complexity Clinical Laboratory Director oversees a state of the art laboratory facility staffed by a skilled team of embryologists. PFC's laboratory has been repeatedly recognized by the College of American Pathologists-American Society for Reproductive Medicine (CAP-ASRM) for maintaining exceptionally high standards.
Our clinic is designed to care for the whole patient, and address the range of complex emotional and logistical needs that often accompany treatment. Our nursing staff is a true partner in this effort, educating and supporting patients and families through every step of evaluation and treatment.
In keeping with this unified approach, PFC associates with a number of highly regarded urologists who provide state-of-the-art care for male factor fertility issues
Meet Our Team
Dr. Agard is passionate about fertility medicine and finds joy in helping each person make their family in their unique way. A Bay Area native, she attended San Francisco State University for her undergraduate studies, and simultaneously conducted research on stem cell differentiation at UCSF. Dr. Agard attended UCLA for medical school, where she discovered her love for women’s health and surgery. She completed her residency in OB/Gyn at Saint Barnabas Medical Center and her fellowship in Reproductive Endocrinology and Infertility at the prestigious Jones Institute, Eastern Virginia Medical Center. The legendary Howard Jones MD, the founding father of IVF, was her mentor.
Dr. Chenette is rated as one of the "Best Doctors in America" by his peers and is a recognized "Top Doctor" in the "Guide to Top Doctors." He is a past recipient of the American Fertility Association's (AFA) prestigious Family Building Award. He has spent the last decade specializing in the treatment of patients with complex infertility diagnoses, especially in women with decreased ovarian reserve, and women over 40. His current work includes optimizing fertility through chromosome testing and fertility preservation.
Dr. Givens was the first in San Francisco to successfully initiate a pregnancy using intracytoplasmic sperm injection (ICSI). She has worked with thousands of in vitro fertilization patients over the last decade. She has developed a special interest in treating couples with more challenging infertility diagnoses including male infertility, women with diminished ovarian reserve, women over 40 and those with genetic problems associated with infertility. She has played an active role in developing and co-directing the Bay Area PGD program.
Dr. Liyun Li, the newest member of our physician team, specializes in endocrine disorders that affect the reproductive system such as polycystic ovary syndrome and hypothalamic/pituitary disorders, in addition to female infertility and IVF. During her years at Columbia, she did extensive research on how metabolic hormones affect egg and embryo health, which resulted in multiple publications in respected peer reviewed journals. She is also a skilled surgeon in laparoscopic and hysteroscopic surgeries. Dr. Li grew up in Shanghai, China, and speaks fluent Mandarin Chinese.
Dr. Ryan gained national recognition with multiple awards for her pioneering research focused on understanding the biological basis for the association between endometriosis and infertility. Dr. Ryan maintains a special interest in treating those patients with the diagnosis of unexplained infertility, and endometriosis. She also enjoys caring for our international patients. At PFC, Dr. Ryan plays an active role directing the Third Party Parenting Program. She remains involved in research focused on improving fertility care.
Dr. Conaghan is internationally recognized for his work with human embryos. He is a board certified High-complexity Clinical Laboratory Director and is an official Reproductive Laboratory Inspector for the College of American Pathologists, as well as an examiner in embryology for the American Board of Bioanalysis. At PFC, Dr. Conaghan directs our state-of-the-art laboratory and actively participates in patient treatment. He guides an exceptional team of human embryologists that focuses on continually improving embryo viability and selection in a safe and meticulously secure laboratory environment.